4. Cardiac causes of cardiac arrest Flashcards
Do all patients with acute MI present with chest pain?
No, some patients, including females and diabetics may present with atypical symptoms of MI including:
1. Arm, throat, back or abdominal pain
2. Breathlessness
What is the overall algorithm for dealing with ACS?
What is the typical type of chest pain associated with acute MI?
- Heavy/tight chest pain
- Often radiates into throat, one/both arms, back or upper abdome
- Usually lasting for >20 minutes
What are typical ECG chages associated with acute MI?
- ST elevation in 2 or more adjacent leads
- New left bundle branch block
What is the time-frame in which patients should receive PPCI following suspected STEMI?
120 minutes (if patient presents within 12hrs of symptoms onset)
What variables are used in the GRACE score?
- age
- signs of heart failure
- heart rate at presentation
- blood pressure at presentation
- serum creatinine presentation
- ECG changes
- troponin concentration
- cardiac arrest at presentation
What immediate treatments should be given in all suspected ACS?
- Aspirin 300mg
- GTN
- Oxygen (only if sats <94%)
- IV opioids for pain relief
What antiplatelet therapy should be used in conjunction with PPCI?
- Aspirin 300mg, then 75mg OD for life
- A stat dose of platelet ADP receptor blocker, then maintenance dosing for at least 1 year:
* Clopidogrel 600mg, 75mg OD
* Prasugrel 60mg (if not >75yrs old, <60kg, hisotry of bleeding or stroke), 10mg OD
* Ticagrelor 180mg, 90mg BD
What adjunct treatments must be given to patients being treated with fibrinolytic therapy for STEMI?
- Aspirin 300mg
- Antithrombin therapy:
* LMWH
* Unfractionated heparin
* Fondaparinux
What is the algorithm for STEMI?
What are the contraindications to fibrinolytic therapy in STEMI?
In patients with NSTEMI, what adjunct treatments should be given?
- Aspirin 300mg, followed by 75mg OD
- Fondaparinux 2.5mg OD
- A platelet ADP inhibitor such as:
* Clopidogrel 600m
* Prasugrel 60mg (if not >75yrs old, <60kg, hisotry of bleeding or stroke)
* Ticagrelor 180mg
Do patients with NSTEMI need PPCI?
No all patients with NSTEMI will require PPCI, only those considered high risk
What arrhythmias are associated with ACS?
- VF/pVT during acute ACS
- Idioventricular rhythm following reperfusion
What are the indications for ICD in patients who experience VF/pVT during ACS?
- None if occurring within 24-48hrs of confirmed ACS, unless persistent LV impairment 4 weeks post ACS
- Patients with sustained ventricular arrhythemias 24-48hrs after confirmed ACS should have inpatient defibrillator and referral to cardiac arrhythmia clinic for consideration of ICD
What are know causes of sudden cardiac death?
